The March of Dimes recognizes Centering Pregnancy® as an evidence based, effective prenatal care model. The Virginia Chapter has provided grant funds for seven projects in the Commonwealth, serving the Northern Neck and the Emporia/Greensville areas. It also sponsors an annual three-day profssional training conference via Eastern Virginia Medical School, held in Portsmouth, VA.

     CenteringPregnancy® and CenteringParenting® are multifaceted group models of care that integrate the three major components of care: health assessment, education, and support, into a unified program within a group setting. Eight to twelve women with similar gestational ages or 5-6 mother/baby dyads meet together, learning care skills, participating in a facilitated discussion, and developing a support network with other group members.  Each Pregnancy or Parenting group meets for a total of 10 sessions throughout pregnancy and early postpartum or through the baby’s first birthday. The practitioner, within the group space, completes standard physical health assessments for women and babies.

     Through this unique model of care, women are empowered to choose health-promoting behaviors.  Health outcomes for pregnancies, specifically increased birth weight and gestational age of mothers that deliver preterm, and the satisfaction expressed by both the women and their providers, support the effectiveness of this model for the delivery of care.

     CenteringPregnancy® groups provide a dynamic atmosphere for learning and sharing that is impossible to create in a one-to-one encounter.  Hearing other women share concerns which mirror their own helps the woman to normalize the whole experience of pregnancy.  Groups also are empowering as they provide support to the members and also increase individual motivation to learn and change. Professionals report that groups provide them with renewed satisfaction in delivering quality care.

     Evaluative data shows that 96% of the women prefer receiving their prenatal care in groups.  This model is interdisciplinary by design and demonstrates high satisfaction on the part of the participating care providers.  Organizing care in this way helps to meet the needs of teens who enjoy being with peers and want to have a healthy baby but tend not to attend separate childbirth education or parenting classes.  The pilot teen groups demonstrated a 92% visit compliance rate. This is an efficient way to organize care and is an attractive model for agencies to implement.

     When CenteringParenting® care is used in conjunction with CenteringPregnancy®, groups provide a continuing community for families for a total of 18 months during this challenging time of transitions and provide an opportunity for competence and confidence building.

     The Centering model was developed by Sharon Schindler Rising, MSN, CNM, and FACNM and piloted in a Connecticut clinic in 1993-94.  Outcome quantitative data and descriptive data from focus group research indicated strong satisfaction of both participants and providers with the model.  The usual mother/baby outcome parameters demonstrated results at least comparable with traditional care.  In addition, there was a statistically significant reduction in emergency department visits by the third trimester.  Recent case control data shows a reduction in low birth weight in infants born preterm of women in Centering groups versus their matched pair in traditional care.   Outcome data from a large randomized controlled trial at Yale/Emory Universities of over 1000 women demonstrates a significant reduction in preterm birth (data submitted for publication).

     Centering models develop in slightly different ways depending on particular needs of the setting, the practitioners, and the women seeking care.  However, there are twelve Essential Elements developed that define the model in all Centering locations.

Essential Elements of the Centering Model

• Health assessment occurs within the group space
• Participants are involved in self-care activities
• A facilitative leadership style is used
• Each session has an overall plan
• Attention is given to the core content; emphasis may vary
• There is stability of group leadership
• The group conduct honors the contribution of each member
• The group is conducted in a circle and group size is optimal to promote the process
• The composition of the group is stable, but not rigid
• Involvement of family support people is optional
• Opportunity for socialization is provided
• There is on-going evaluation of outcomes

Centering Pregnancy and Parenting Association, Inc.
A non-profit organization, Centering Pregnancy and Parenting Association, Inc., supports the development of the model through educational workshops, consultation and research.  The mission of Centering Pregnancy and Parenting Association, Inc (CPPA) is to change the paradigm of health services to a group care model in order to improve the overall health outcomes of mothers, babies, new families and all individuals across the life cycle.

This mission is based on the belief that the Centering model:

• Improves the health and well-being of childbearing women and their families
• Empowers women through a process of education and self-care;
• Creates a network of support for women and families, thereby strengthening their communities;
• Promotes the professional growth and satisfaction of health care providers delivering Centering care; and
• Increases the effectiveness and efficiency of the health care delivery system.

     A number of formal research studies are underway funded both by government and private sources in Centering groups versus their matched pair in traditional care. Outcome data from a large randomized controlled trial at Yale/Emory Universities funded by NIMH of over 1000 women demonstrates a significant reduction in preterm birth, increase in satisfaction, breastfeeding rates, and pregnancy spacing for women in group care (data submitted for publication). The March of Dimes both nationally and through its state chapters has funded studies and provided site start-up monies.

     Centering is a concept that is finding strong acceptance by professionals who offer the model and by the women/couples who participate in the program.  It is a model that should be of interest to public and private agencies as well as to independent practitioners and is utilized by midwives, nurse practitioners, and physicians at over 200 sites nationally and internationally.  We encourage any who are interested to explore its potential by inviting Centering experts to speak, lead workshops and provide consultation.  A full range of patient and professional materials are available to help sites implement the model.
    

     For further information:  http://www.centeringpregnancy.org/ or contact CPPA at: info@centeringpregnancy.org   or 203:271-3632
    

     The March of Dimes recognizes Centering Pregnancy® as an evidence based, effective prenatal care model. The Virginia Chapter has provided grant funds for seven projects and sponsors an annual two-day training conference.  For additional information, contact Sara Long, Director of Program Services 804-968-4120 or slong@marchofdimes.com.

Selected Bibliography

Baldwin K. (2006) Comparison of selected outcomes of CenteringPregnancy versus traditional prenatal care.  JMWH, 51(4): 266-72.

Grady MA, Bloom K. (2004) Pregnancy outcomes of adolescents enrolled in a CenteringPregnancy program. JMWH, 49(5):412-20.

Ickovics J, Kershaw T, Westdahl C, Rising SS, Klima C, Reynolds H, Magriples U. (2003) Group prenatal care and preterm birth weight: results from a matched cohort study at public clinics. Obstetrics and Gynecology.  102(5) 1051-57.

IckovicsJ, Kershaw T, Westdahl C, Magriples U, Massey Z, Reynolds H, Rising, S. (2007) Group prenatal care and perinatal outcomes: a randomized controlled trial.  Obstetrics and Gynecology, 110(2), part 1: 330-39.

Klima C. (2003) Centering Pregnancy: a model for pregnant adolescents.  J of Midwife &    Women’s Health, 48 (3): 220-25.

Massey Z, Rising SS, Ickovics J. (2006)  CenteringPregnancy group prenatal care: promoting relationship-centered care.  JOGNN, 35(2):286-94.

Novick, G. (2004) CenteringPregnancy and the current state of prenatal care. JMWH, 49(5): 405-11.

Rising SS.  (1998) Centering pregnancy: an interdisciplinary model of empowerment. J of Nurse-Midwifery.  43(1) 46-54.

Rising SS, Kennedy HP, Klima C. (2004) Redesigning prenatal care through CenteringPregnancy. JMWH, 49(5):398-404.

Walker D, Rising S. (2005) Revolutionizing prenatal care: new evidence-based prenatal care delivery models.  J of NY State Nurses Assoc.  Fall/Winter 2004/2005: 18-21.